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Caution is advised in patients with Leber optic atrophy, a genetic disorder caused by chronic cyanide intoxication (such as from smoking, alcohol or some plants), against the use of cyano-B12 due to its cyanide moiety, whilst hydroxo-B12 is a cyanide antagonist and can therefore be used in these patients

Punctured vials during travel: Vials in active multi-dose use require the same storage discipline during travel as at home: temperature control, light protection, and aseptic technique on every draw

Akt activates mTORC1, which phosphorylates the translational regulators S6K1 and 4E-BP1 to increase ribosomal biogenesis and cap-dependent translation the molecular basis of increased protein synthesis

Nakamura T, Prikhodko OA, Pirie E, Nagar S, Akhtar MW, Oh C-K, et al

Proc Natl Acad Sci U S A 98(16):94079412

They can affect hydration, medication timing, and the ability to keep regular meals down